Deb Kappes: Fearmongering is behind opposition to dental therapists

I have been part of the oral healthcare community for over 40 years as a private practitioner and dental-hygiene educator. I can speak firsthand to the importance of providing safe, quality dental care to all Arizonans and especially our children.

As safety is paramount, so is access to treatment.

Today, 4.6 million Arizonans live in a federally designated Dental Health Professional Shortage Area, which is usually defined as having fewer than 1 dentist per 5000 people.

Coconino Voices: Dental therapists would fill oral care gap on Rez

If you’ve ever suffered from tooth pain, you know the throbbing, aching feeling that goes all the way to your very core. When you have that kind of dental pain, you can’t get to the dentist fast enough. Now imagine that same pain in your child’s mouth. If you’re me, and you’ve raised your children on the Navajo Nation, the nearest dentist is likely 1 to 3 hours away. But that might not be the biggest hurdle, because even if you get there, there’s no guarantee that there will be a dentist available to treat your child. As a parent, you’re helpless. You’re trying to access care that simply isn’t available.

Will states take the lead on healthcare?

At a time of seemingly intractable partisan acrimony over healthcare in Congress, prospects for comprehensive reform remain dim. But, when it comes to delivering on healthcare access and affordability, there are some bright spots in the states.

One state to watch is Arizona where lawmakers are inching closer to delivering on a significant reform that promises more accessible and affordable dental care. Somewhat like nurse practitioners, SB 1377 would allow for mid-level dental providers. This effort is an urgent priority as the state faces a severe dental crisis.

Mike Broomhead with Rep John Kavanagh

Dental therapists needed to extend care

Tribal leaders, representatives and advocates from across the country met in Scottsdale to discuss ways to improve access to oral health for their communities. As a member of the Salt River Pima-Maricopa Indian Community, the issue of dental care access is an important one for me and the people in my community.

Arizona is currently home to 22 individual sovereign tribal nations with 394,196 tribal members living on and off reservations. Our tribal nations have grappled for decades with a shortage of dentists willing to work for the Indian Health Service and tribal facilities.

Bill would solve Arizona’s dental health crisis

As of December 2017, more than 4.6 million Arizonans live in a federally designated dental health professional shortage area. In fact, compared to the rest of the United States, Arizona has the highest percentage of its population living in a federally-designated shortage area. And this crisis impacts every corner of our state, including large portions of all 15 counties, and all of Graham, Greenlee, La Paz, Santa Cruz and Yuma counties.

The shortage of available dental providers hits especially hard in poor neighborhoods, tribal communities and rural areas. Although children are covered for dental services under AHCCCS, sadly less than half received any dental care at all in 2016.

'Dental therapy' closer to becoming a new Arizona profession

The issue remains divisive, but dental therapists are closer to becoming a new, licensed profession in Arizona.

Over the objection of dentists, Arizona’s Senate health committee voted 4-3 Wednesday to move forward a bill that would establish dental therapists as “mid-level” providers, who would play a role similar to that of nurse practitioners and physician assistants in the medical world.

The debate pitted dentists from the Arizona Dental Association against a coalition that includes tribes, the conservative Goldwater Institute and the Arizona Rural Health
Association, among others.

Chester Antone: Dental therapists good for tribes, good for Arizona

Millions of people throughout Arizona face significant challenges when it comes to accessing dental care and treatment of dental disease. Nowhere in Arizona is need more acute than on the American Indian reservations. There is a proven model using mid-level dental providers that can increase access to affordable, quality oral health care. However, the opposition from organized dentistry is fierce.

Local dentists who for years volunteered their services at Tucson’s Hope Fest are skipping this weekend’s charity gathering, working instead on a way to offer free care on a more ongoing basis.

The need for free dental care here is too huge to offer it in a one-day event like Hope Fest, they say. The annual event for low income residents offers free hygiene items, haircuts and medical services, among other things, and regularly attracts upward of 10,000 people. It was set for Saturday at the Tucson Convention Center.

For the first time in at least 20 years, no dental services were to be offered.

The Growing Gap in Oral Healthcare for Arizona’s Hispanic Children

As the national debate over healthcare grows and our country grapples with changes to the Affordable Care Act, let us not lose sight of our state’s specific challenges in providing care for the most vulnerable among us.

At Valle del Sol, we see these challenges on a daily basis. For the past 44 years, we’ve worked tirelessly to fill an ever-widening gap in health services available to our Latino community. One of the most pressing community health issues today is also one that is often overlooked – early and affordable access to dental care for Hispanic children.

Frontlines of dental care show tremendous need in Arizona

In a recent article titled, “Dental therapist proposal to get new hearing before lawmakers,” Arizona Capitol Times readers heard from legislators that they do not believe we have a dentist shortage here in Arizona, despite overwhelming evidence, and federal reports, to the contrary.
That same article provided data from the U.S. Department of Health and Human Services showing that we have numerous counties designated as “health professional shortage areas” with 435 dentists needed to fill the need throughout the state.

Even more recently, dentists and hygienists will not be participating in Hope Fest, Tucson’s annual event for low income residents to receive free hygiene and, historically, dental care. The event usually attracts more than 10,000 Arizonans from the Tucson area. Even the Arizona Dental Association agrees that this single event cannot address the systemic shortages and need in our community.

‘Now I Can Restore a Smile’

Patients in rural Minnesota often travel two hours and more for an appointment with Brandi Tweeter. The dental therapist practices in the city of Montevideo, population 5,400, about 45 miles from the South Dakota line. Why do patients travel so far to see her?

Simply put, they can’t get proper dental care any other way. The services Tweeter offers—prevention and routine restorative care—are often difficult to obtain in rural communities, which tend to attract fewer dentists. The patients who live there often lack insurance or the ability to pay, as well.

Study finds that rural Alaska dental aides, once challenged by dentists, make a difference in oral health

In villages served the most by dental health aides, children and adults had more preventive care and fewer extractions, cutting down on one of the worst outcomes in dentistry, the study found. Teeth are pulled when they can’t be restored, usually because of decay.

“That tells us the therapists are really making a difference in these communities. And the more care they are providing in these underserved communities, the more preventative care and the fewer extractions people are getting,” said the lead researcher, Donald Chi, an associate professor at the University of Washington School of Dentistry in Seattle and a pediatric dentist with clinical experience in the Y-K Delta.

Coming Up: Stakeholder Meeting

As planned, our next steps will be to schedule a meeting with stakeholders, including the Arizona Dental Association and other members of the oral healthcare industry in our state, to talk about how we can work together to continue increasing access to quality care for all Arizonans.

Below you will find additional links to news stories and reports about dental therapy over the last few weeks.

Dental tourism shows need for reform

Border crossings are a hot topic in American politics right now. But a different kind of border crossing has received far less attention. Arizonans are crossing into Mexico in droves to access dental care that is either unavailable — or unaffordable — in Arizona. Dental patients are traveling to towns such as Los Algodones, dubbed “Molar City,” which sits across the U.S.-Mexico border near Yuma. This small Mexican town is home to about 5,500 residents — and about 350 are dentists. Nogales, Sonora, is also a rising dental-tourism destination.

Arizona patient Ramon was not only satisfied with his care, but he also paid about $300 for a treatment that would have cost him about $1,500 at home. This trend has become so popular that one Tucson dentist is offering prescreened referrals to Mexico dentists and shuttle service across the border.

KJZZ’s The Show Discusses the merits and debate around Dental Therapy

Earlier this week, we talked about the idea of allowing dental care therapists to be licensed in Arizona, as a way to bring dental care to residents who currently aren’t getting it. Kristen Mizzi Angelone, dental policy expert for the Pew Charitable Trusts, explained what these mid-level providers do.

A report from the Goldwater Institute finds almost 2.5 million Arizonans are living in areas designated as dental health professional shortage areas. It advocates for allowing dental therapists as a way to bring that number down.

But not everyone thinks that’d help. Kevin Earle is the executive director of the Arizona Dental Association.

America Doesn't Have Enough Dentists

When state Rep. Jason Sheppard (R-Lambertville) was a county commissioner in Monroe County, Michigan, the local community health clinic decided to start offering dental services. In one way, the effort was a success: “There was an immediate influx of patients,” Sheppard recalls. The only problem? Finding dentists to treat them.

That sort of supply-side problem in health care is not unique to Michigan. According to the U.S. Department of Health and Human Services, more than 5,000 localities lack adequate access to dental care, which the department defines as having fewer than one dentist for every 5,000 residents. About 55 million Americans live in those areas. In Michigan alone, there are 270 such zones, mostly in inner cities and rural areas.

Lawmakers should smile upon dental therapist bill

Too many Michigan residents can’t get access to the dental care they need — and it’s costing taxpayers dearly.

Without access to routine and preventative dental care, many people turn to the most expensive place to treat their symptoms: the emergency room. Although ER doctors can provide temporary relief to patients suffering from pain, underlying dental problems are too often left to fester. Plus, ER services costs about five times more than the preventative care would have cost at a dentist’s office.

Mass. studies use of dental therapists

Some families travel for hours to get to Children’s Dental Services in Minneapolis, seeking relief from a mouthful of cavities or a painful tooth.

Often, these children wind up in Gina Buchal’s chair. But Buchal is not a dentist; she’s a dental therapist, an emerging field of health care providers created by a 2009 Minnesota law.

Buchal can perform many of the procedures typically done by dentists, such as tooth restoration and some extractions. Proponents say such mid-level providers play a critical role by treating low-income patients unable to find a dentist who will accept their public insurance.

Dentists to poor people: Drop dead

Dentists, who seem like perfectly nice people when you meet them at after-school events or at the grocery store, are carving out a bizarre public persona that is a mixture of Simon Legree, Snidely Whiplash, and Dr. Evil.

The women and men who fix your teeth now make more money per capita than doctors. To preserve their high incomes, dentists have historically refused to participate in Medicare because of low reimbursements, and ditto for Medicaid. Now dentists are resolutely — some would say fanatically — opposing efforts to let dental hygienists and dental therapists deliver prophylactic care to children, the elderly, and to poor and underserved regions in America.

It’s Incredibly Hard to Get Dental Care in Rural America

Two and a half hours west of the Twin Cities, where the Minnesota and Chippewa rivers meet, is the prairie village of Montevideo, Minnesota. Downtown consists of a post office, railroad tracks, a few storefronts, and a dentist’s office called Main Street Dental Care. From the outside, the clinic doesn’t look like much. But on the bitter February day I visited, inside it was buzzing with activity.

Down the hall from the full waiting room, bent over her dental chair, Brandi Tweeter had a full roster of patients. Some had traveled hundreds of miles to see her, she told me. That’s not unusual: In Minnesota, there’s about one dentist for every 1,500 people—but they’re concentrated in cities. Here in Chippewa County, the ratio is 1 in about 2,400. In a neighboring county, it’s 1 in more than 5,000.

6 years in, dental therapist experiment is working, experts say

Eight years ago, the Minnesota Legislature authorized the licensing of mid-level dental care providers, known as dental therapists, to practice in Minnesota. The new career was supposed to expand access to dental care to more state residents, especially those with low incomes or who live in rural areas where dentists may be rare.

Comparable to a nurse practitioners, the first dental therapist graduates began seeing patients in 2011. Six years later, those benefits are materializing, according to Sharon Oswald, foundation and community affairs program manager with Delta Dental of Minnesota. A 2016 study by the University of Minnesota found dental therapists saw up to 90 percent of uninsured patients or patients on public assistance.

Washington tribe beats dental lobby, gets dental therapy

After years of failed efforts to pass a dental therapy law in Washington, an Indian tribe took a page from their counterparts in Alaska and exercised their sovereignty to get it done.

The Swinomish Indian Tribal Community accomplished something few others have been able to do: get the powerful dental lobby to stand down, thus paving the way for overwhelming bipartisan support for dental therapists.

Another Study Proves the Benefits of Dental Therapy

We’re also very excited to share with you a recent long-term study coming out of Alaska, where tribes have been utilizing dental therapy despite the American Dental Association suing to stop the program. Fortunately for Tribes in Alaska, the suit failed and today they are experiencing positive impacts at levels not seen since fluoridating the public drinking supply. Please follow this link to learn more about these impressive and important outcomes.

The National Conversation on Dental Therapy Continues...

Outside of Arizona, the national conversation also continues. We especially want to share this story about the ongoing challenge of accessing oral healthcare in rural America.

A Day in the Life of a Dental Therapist

In addition, we often get questions about just what a dental therapist is and does day to day. With so many excellent outcomes coming out of states like Minnesota, where dental therapy has been available for a number of years, The Pew Charitable Trusts has put together a powerful profile of Jodi Becker, who crisscrosses the state serving rural and other underserved areas. Please take a moment to enjoy her story and learn more about the powerful impact dental therapists are having across Minnesota.

Sunrise Application Submitted

On September 1st, Dental Care for Arizona submitted our Sunrise Application with the Arizona Legislature for the licensure of dental therapists. In our application, we cited numerous issues facing the state when it comes to the urgent need for improved access to oral healthcare, including the fact that more than 2.4 million Arizonans currently lack access to sufficient dental health providers. Follow this link to our press release for your reference.

Dental Therapy in the News

We also want to point out a few news stories that have appeared about Dental Therapy here in our great state, one from the Daily Sun and another from the Business Journal (Please note that the Business Journal story is behind a pay wall). Overall, the coverage is fair and well-balanced. While the AzDA continues to insist that Arizona doesn’t have an access issue, many in our coalition know otherwise through first-hand experience. Many organizations struggle to find dentists who will even accept AHCCCS patients, never mind provide the scale and viable fee structures that would empower you to help even more of the millions of underserved Arizonans throughout our state and in our Tribal communities.

Support for Dental Therapy Builds

In addition, we want to thank Representative Bob Thorpe, who penned an Op Ed in support of Dental Therapy and how it can help alleviate access issues in rural Arizona. His Op Ed appeared in the September 5th edition of the Daily Sun.

Many Poor Communities Lack Adequate Dental Care; Here's and Easy Way to Fix That

It’s a conclusion that almost seems too obvious. Communities with greater access to dental care have fewer children and adults with serious dental problems.
READ MORE: Reason.com

Study Finds Oral Health Outcomes for Alaska Native Communities Served by Dental Therapists Better Than for Those Without

Children had lower rates of tooth extractions and more preventive care in Alaska Native communities served frequently by Dental Health Aide Therapists (DHATs) than residents in communities not receiving any DHAT services, according to a new study released by the University of Washington.
READ MORE: Red Lake Nation News

There is considerable debate in the U.S. about dental therapists but often a lack of outcomes data behind both sides of the argument.
READ MORE: Dr.Bicuspid.com

Build a healthier Michigan by expanding access to dental care through the authorization of dental therapists

I’ve seen firsthand the tremendous impact the lack of access to oral healthcare can have on a child.

Approximately half of the kids covered by Healthy Kids Dental in Michigan did not receive dental services in 2016. More than 1 in 4 third-graders across the state suffer from untreated dental disease. Dental problems cost children countless hours of lost school time, cause pain and can impact a child’s self-esteem, nutrition, as well as their ability to eat, sleep, communicate and concentrate in school.

Programs like Give Kids a Smile make a difference, but they aren’t enough.